Can OT Discharge Placement Recommendations Reduce Hospital Readmissions for Patients With Low Socioeconomic Status?

The aim of this project is to determine if occupational therapists make accurate hospital discharge placement recommendations for patients with low socioeconomic status. Hospitals must control unexpected readmission rates to avoid penalties from the Hospital Readmission Reduction Program (Medicare) for higher than average rates of readmission (Zuckerman, Sheingold, Orav, Ruhter, & Epstein, 2016). Thus, it is important to determine what factors may decrease unexpected readmission to the hospital. One such factor is patients with a low socioeconomic status who, according to the literature, have a greater chance of having unexpected readmissions than their peers. While studies highlight the effectiveness of an interprofessional approach to effective discharge planning (Wong et al., 2011), there is limited evidence to support the effectiveness of occupational therapy discharge recommendations on hospital readmissions in general and for this population. For this study, it was hypothesized that because of occupational therapy’s holistic perspective of patients’ personal needs and risk factors for readmission to the hospital, occupational therapy discharge recommendations would accurately predict patients discharge placement. This quantitative retrospective study collected discharge and readmissions data between March 2016 and August 2016 from medical charts of patients with a low socioeconomic status. 394 charts were included in this study. 311 patients discharge placements matched the occupational therapist’s recommendation. Only 46 (14.8%) of the patients discharge placements that matched the occupational therapists’ recommendations had an unplanned readmission. However, 83 patients discharge placements mismatched the occupational therapist’s recommendation. 26 (31.3%) of the patients that had a mismatch with the occupational therapist’s recommendation, had an unplanned readmission. Chi-squared analysis of the data indicated a relationship between mismatched recommendations and likelihood of readmissions of 11.993 with a p value of .001 [x2 (1, n=394) = 11.993, p < .001]. A logistical regression analysis showed the likelihood of readmission was 2.63 times higher for those with a mismatch in recommendations. Therefore, patients with a low socioeconomic status may have a lower chance of having an unexpected readmission to the hospital when they follow the occupational therapists’ discharge placement recommendations. The findings from this study help support the effectiveness of occupational therapy hospital discharge planning and its possible impact on helping to reduce the cost of hospitalization for people with low socioeconomic status.

References

Jette, D. U., Grover, L., & Keck, C. P. (2003). A qualitative study of clinical decision making in recommending discharge placement from the acute care setting. Physical Therapy, 83(3), 224-236. https://doi.org/10.1093/ptj/83.3.224

Wong, E. L., Yam, C. H., Cheung, A. W., Leung, M. C., Chan, F. W., Wong, F. Y., & Yeoh, E.-K. (2011). Barriers to effective discharge planning: a qualitative study investigating the perspectives of frontline healthcare professionals. BMC health services research, 11(1), 242.